Sep. 29, 2011

Video Game Can Reduce Fatigue in African-American Women With Lupus

Using Wii Fit to reduce fatigue among African American women with systemic lupus erythematosus: A pilot study.
Yuen H, Holthaus K, Kamen DL, Sword D, Breland HL. (2011).  Lupus. 2011 Jun 23. [Epub ahead of print]

What is the topic?

Lupus affects many more women than men and many of these women are African-American. Over 80% of people with lupus experience clinically significant levels of fatigue that can disrupt normal daily activities. This fatigue is not necessarily due to use of medications for lupus or to inflammation. 

Much research indicates that exercise can be one of the most effective strategies to reduce fatigue. Interestingly, the incorporation of game activities to exercise regimens can increase motivation for and enjoyment of exercise. 

Wii Fit is an interactive video game system that connects to a television and allows users to participate in a variety of guided exercises. Wii Fit can be a useful tool because it provides individualized feedback about multiple exercise-related parameters. Wii Fit has been shown to be an effective strategy to increase fitness in middle-aged and older adults, but has never been used to evaluate fatigue in humans with lupus. 

What did the researchers hope to learn?

The researchers hoped to learn the effects of a 10-week, home-based exercise program, Wii Fit, on fatigue, emotional state, sleep, and pain in African-American women with lupus. Weight and waist circumference were also measured.

Who was studied?

Fifteen African-American women with lupus were included in the study. They were recruited to the study via the Medical University of South Carolina Lupus Clinic.

The following were inclusion criteria: a) females aged 18 and older; b) self-identification as African-American; c) diagnosis of lupus; d) ambulatory (i.e., capable of walking and movement); e) experienced fatigue (to a specific criteria) for at least three months; sedentary (i.e., exercised less than three times per week for 30 minutes in the past six months); f) functionally literate (i.e., able to read and follow directions written in English); and g) had permission from a physician to participate in the study. 

The following excluded patients from participating in the study: a) cognitive dysfunction (unusually poor mental function associated with confusion, forgetfulness, and difficulty concentrating) based on specific neuropsychological testing; b) anemia (reduced hemoglobin in the blood); c) poor control of metabolic diseases or other health problems known to contribute to fatigue (such as infections or malnutrition); d) known abnormalities of electrolytes (sodium, potassium, and chloride in the blood); e) documented diagnosis of major psychiatric disorders such as melancholia; f) severe visual and/or hearing impairment that cannot be corrected by assistive devices; g) significant functional impairments due to heart disease, arrhythmias, chronic pulmonary disease, or conditions of the hip or knee, or severe arthritis that prevents exercise; and h) high blood pressure meeting specific criteria. 

How was the study conducted?

A research coordinator initially contacted by phone those patients being seen at the Medical University of South Carolina Lupus Clinic to discuss potential participation in the study. For patients who met the inclusion criteria, the research coordinator scheduled an initial home visit to obtain further information and provide instructions about participation in the study. Upon entry to the study, as well as after the 10-week Wii Fit exercise program, participants were evaluated via questionnaires for severity of fatigue, anxiety or depression, sleep quality, and experience of pain. Weight and waist circumference were also measured. The research coordinator gave each participant an activity monitor, trained them to use it, and requested that they wear it around the waist during waking hours throughout the study period. Participants were required to demonstrate competence in the use of Wii Fit to participate in the study.

Participants were to exercise with Wii Fit (with exercise games they enjoyed) for 30 minutes three days per week over a consecutive 10-week period. Participants could start by exercising 10-20 minutes during initial sessions, but were encouraged to gradually increase to 30 minutes per session. Each session was to start off with a five-minute warm-up period followed by aerobic exercise and strength training, as well as a five-minute cool-down period.

In order to avoid exacerbating fatigue or provoking unwanted conditions (such as pain, dizziness, or nausea) participants were instructed to maintain their exercise intensity at a perceived exertion level of “fairly light” to “somewhat hard.” All exercise procedures followed the guidelines of the American College of Sports Medicine for a conditioning program and were similar to other exercise procedures developed for people with lupus. 

After two weeks of weekly, supervised home exercise, the research coordinator conducted weekly telephone monitoring sessions in order to check on progress, encourage adherence, answer questions, and help resolve barriers to exercise. The research coordinator also visited participants at home every three weeks for nine weeks in order to download data from the Wii Fit activity monitor and to complete exercise program evaluations mid-way, as well as at the end of the ten weeks. 

What did the researchers find?

Fifteen African-American women with lupus participated in the study. They were, on average, age 47 (but ranged from 25 – 67 years old) and had lupus for an average of 16 years (but ranged from 3 – 40 years). Upon entry to the study, the participants (on average) reported experiencing “severe fatigue.” Upon entry to the study, nine participants were post-menopausal and five were taking prednisone. Overall, participant adherence to the exercise program was about 64%, with 60% of participants achieving more than 73% adherence. 

After the 10-week Wii Fit exercise program, the participants reported experiencing significantly reduced fatigue (reduced by 18% as compared to fatigue at study entry), anxiety, pain, weight, and waist circumference. After the 10-week study, the following were somewhat reduced, but not to significant levels: depression, sleep quality, and perceived physical exertion. No new lupus-related damage (as measured by a lupus damage index) was accrued in any of the participants following the exercise program.

What were the limitations of the study?

The researchers could not be certain that family members did not use the Wii Fit machine specified for use only in the participating lupus patients. Since the Wii Fit program has a built-in system to record exercise-related parameters, the possibility that use of the system by family members affected the results obtained in the current study is real. Also, some of the participants forgot to wear the activity monitor during waking hours after the initial few weeks, as instructed. Furthermore, the current study did not include a group of participants who used a non-computer based home exercise program. Inclusion of such a group in future studies that evaluate exercise-related parameters for longer periods of time would help to further define the beneficial effects of an at-home, computerized exercise program in people with lupus. Furthermore, the study did not include a control group of people without lupus to assess if the improvements in fatigue were different between lupus and non-lupus patients. 

What do the results means for you?

This pilot study illustrates that a home-based Wii Fit exercise program is safe for use in people with lupus, and is adhered to fairly well. The results provide preliminary evidence that this program can motivate people with lupus to exercise and can effectively reduce fatigue, anxiety, pain, weight, and waist circumference. However, this exercise regimen should be explored in a large number of patients before it can be recommended to lupus patients. It is also unclear if this exercise regimen would be superior to other non-computer based home exercise programs which may be less costly. People with lupus should always consult a physician before beginning any regular exercise program.

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